El Cuestionario de Salud SF-36 español: una década de experiencia y nuevos desarrollos

Translation and validation of 'The Knee Society Clinical Rating System' into Spanish

PURPOSE

The Knee Society Clinical Rating System (KSS) is a questionnaire evaluating knee function itself and the patient's ability to walk and climb stairs. The aim of our study is to present the validated translation of KSS into Spanish.

METHODS

The validated method of translation-retrotranslation was used to translate KSS into Spanish. Three hundred and sixteen patients undergoing primary knee arthroplasty, before surgery and 6 months postoperative, completed the questionnaire (with an orthopedist's help). Psychometric properties of feasibility (percentage of no answers), validity and sensitivity to change (test's ability to detect change in patients' functional status over time) were assessed. In the second part of the study, the translated version of KSS was compared with two already validated questionnaires (SF-36 and WOMAC).

RESULTS

During the translation process, item 3 (ROM) presented low appropriateness and null comprehensibility. The alternative writing proposed was 'for every 5°, we sum up 1 point, as if 8° were 1 point, to obtain the maximum scoring of 25 points you should bend more than 200°'. Feasibility: the item 'malalignment' obtained 15 % of missing item at visit 1. The percentage of invalid items was high in both visits (60 and 47 %).

VALIDITY

the coefficients of convergent correlation with WOMAC and SF-36 scales confirm the questionnaire's validity. Sensitivity to change: significant differences were found in all cases between the mean scores comparing both visits.

CONCLUSION

The translated version 1.1 of KSS (final version) has shown to be feasible, valid and sensible to changes within the clinical practice of patients undergoing primary knees arthroplasty.

Validation of a Spanish version of the Revised Fibromyalgia Impact Questionnaire (FIQR)

BACKGROUND

The Revised version of the Fibromyalgia Impact Questionnaire (FIQR) was published in 2009. The aim of this study was to prepare a Spanish version, and to assess its psychometric properties in a sample of patients with fibromyalgia.

METHODS

The FIQR was translated into Spanish and administered, along with the FIQ, the Hospital Anxiety Depression Scale (HADS), the 36-Item Short-Form Health Survey (SF-36), and the Brief Pain Inventory (BPI), to 113 Spanish fibromyalgia patients. The administration of the Spanish FIQR was repeated a week later.

RESULTS

The Spanish FIQR had high internal consistency (Cronbach’s α was 0.91 and 0.95 at visits 1 and 2 respectively). The test-retest reliability was good for the FIQR total score and its function and symptoms domains (intraclass correlation coefficient (ICC > 0.70), but modest for the overall impact domain (ICC = 0.51). Statistically significant correlations (p < 0.05) were also found between the FIQR and the FIQ scores, as well as between the FIQR scores and the remaining scales’ scores.

CONCLUSIONS

The Spanish version of the FIQR has a good internal consistency and our findings support its validity for assessing fibromyalgia patients. It might be a valid instrument to apply in clinical and investigational grounds.

Impact of osteoporosis and bone fracture on health-related quality of life in postmenopausal women

BACKGROUND

Osteoporosis is responsible for fragility fractures, which are associated with decreased physical and social function. The GINERISK study was a cross-sectional epidemiological study conducted in 4157 Spanish postmenopausal women initially diagnosed with osteoporosis according to WHO criteria within the last 2 years.

AIM

The aim of the study was to explore the impact of osteoporosis on health-related quality of life (HRQoL).

METHOD

Menopause-specific and generic HRQoL were assessed, respectively, with the specific Cervantes Scale and the generic SF-12v2 Health Survey. The impact of osteoporosis on HRQoL was ultimately evaluated in 3328 (80.1%) women who had measurements for both bone mineral densitometry (BMD) and HRQoL.

RESULTS

Menopause-specific or generic HRQoL, respectively, were worse in women with current osteoporosis and prior osteoporotic bone fracture (BF) in comparison with current osteoporosis without BF or whose T-score had increased above -2.5 on the BMD after receiving osteoporosis drug therapy. Impaired HRQoL was found both in Spanish postmenopausal female populations and the Spanish general female population. Women with osteoporosis with BF had physical and mental summary component scores in the 20th and 30th percentiles, respectively, of the Spanish general population. Higher risk for cardiovascular death was also associated with greater HRQoL impairment. The use of selective estrogen receptor modulators in women with a BMD T-score ≤ -2.5 was associated with lower impact of osteoporosis on HRQoL, particularly in the domains of physical health and sexuality.

CONCLUSION

The HRQoL analysis results in this study demonstrated a loss of quality of life in postmenopausal women with osteoporosis and confirmed that this loss is greater in women with prior osteoporotic fracture.

Factores psicosociales predictores de la calidad de vida en personas en situación de discapacidad física

El presente estudio correlacional descriptivo se propuso evaluar los factores que determinan la calidad de vida (CV) relacionada con la salud en 78 personas con discapacidad física que vivían en Bogotá, y hacían parte de un proyecto de inclusión laboral dirigido por una ONG. Se evaluó la calidad de vida relacionada con la salud (Cuestionario de Salud SF36 y visita domiciliaria), al igual que las condiciones asociadas a la discapacidad y algunos factores psicológicos (Escala de Autoeficacia Generalizada, Prueba de Imagen Corporal, Inventario de Estilos de Afrontamiento, Prueba de optimismo disposicional, Inventario de Depresión de Beck y Escala de Ansiedad de Zung). Se utilizó un modelo de ecuaciones estructurales para encontrar el poder predictivo de las variables en la calidad de vida. El modelo obtenido predecía un 39% de la varianza, incluyendo en orden de peso relativo aportando variables como condiciones de enfermedad, depresión, afrontamiento centrado en la fantasía, trascendencia, pesimismo, ansiedad y autoeficacia. Se discuten los hallazgos y las limitaciones del estudio.

[Quality of life-associated factors at one year after total hip and knee replacement: a multicentre study in Catalonia]

AIMS

To assess the health related quality of life (HRQOL) and associated factors of patients before, and one year after, total knee (TKA) and hip (THA) arthroplasty.

METHODS

A quasi-experimental prospective study conducted in hospitals with different levels of complexity and volume in Catalonia, and on patients with an indication of a TKA or THA. Demographic and psychosocial variables were recorded, and the SF-36 and WOMAC, and a question on perception of change after surgery were administered to patients by telephone interview. The standardised differences (effect size) of perceived change using the SF-36 and WOMAC scores before and after surgery were calculated. The factors associated with HRQOL one year after surgery were analysed using adjusted general linear models.

RESULTS

Although there was an overall improvement in most HRQOL domains of patients (n=672), 9% saw little improvement after surgery, with their scores at baseline and follow-up being very similar (small size effect: 0.0-0.4). Women, patients with low social support, with lower scores (worse) in perceived mental health and baseline HRQOL, and who declared that their condition was more severe, perceived a poorer HRQOL one year after surgery (P<.05).

CONCLUSIONS

Factors associated to a worse prognosis one year after an arthroplasty have been identified and are consistent with other published studies. The assessment of HRQOL can be a key instrument for identifying possible patients without improvement, in order to assess alternatives to an intervention, or apply other interventions in order to improve the efficiency of the healthcare process.

[Effectiveness of a stretching program on anxiety levels of workers in a logistic platform: a randomized controlled study]

Objetivo

Evaluar la efectividad de un programa abreviado de estiramientos sobre los niveles de ansiedad de los trabajadores de una empresa logística española.

Método

Se llevó adelante un ensayo clínico controlado, con un diseño inter-sujetos, aleatorizado mediante conglomerados. Los participantes fueron asignados al grupo experimental (n = 67), tratado con un programa de estiramientos, de 10′ de duración tras la jornada laboral, durante 3 meses, o al grupo control (n = 67), no tratado. La variable resultado principal fue la ansiedad estado y las variables secundarias el burnout, la calidad de vida y la flexibilidad. Se llevó a cabo un análisis de covarianza (ANCOVA) por intención de tratar sobre las variables resultado, controlando las puntuaciones basales, la edad y la práctica de actividades introyectivas fuera del programa, calculando el tamaño del efecto mediante eta cuadrado parcial (η²).

Resultados

Los resultados del ANCOVA señalaron un efecto moderado del programa de estiramientos sobre la ansiedad (η² = 0,06; p = 0,004). También se encontraron efectos elevados en flexibilidad (η² = 0,13; p < 0,001), moderadamente altos en dolor corporal (η² = 0,08; p = 0,001), moderados en vitalidad (η² = 0,05; p = 0,016), salud mental (η² = 0,05; p = 0,017), salud general (η² = 0,04; p = 0,028) y agotamiento (η² = 0,04; p = 0,025).

Conclusiones

La implementación de un programa de estiramientos en el lugar de trabajo resultó eficaz para disminuir los niveles de ansiedad, dolor corporal y agotamiento, así como para aumentar la vitalidad, salud mental, salud general y flexibilidad. Este tipo de intervención podría constituir una estrategia de bajo coste para la mejora del bienestar de los trabajadores.

Chronic mountain sickness score was related with health status score but not with hemoglobin levels at high altitudes

Chronic mountain sickness (CMS) or lack of adaptation to live in high altitudes is related to environmental hypoxia and excessive erythrocytosis (EE) (hemoglobin >21 and >19 g/dL for men and women, respectively). Diagnosis of CMS ("Qinghai CMS Score") is based on seven signs/symptoms (breathlessness and/or palpitations, sleep disturbance, cyanosis, dilatation of veins, paresthesia, headache, tinnitus) and the score for EE. The present study was designed to determine the association between hemoglobin, Qinghai CMS score, CMS clinical score (7 signs/symptoms) and Health Status using a health survey composed of 20 items. The rate of CMS (32.6%) was higher than the rate of EE (9.7%; P<0.002). A significant inverse relationship was observed between CMS clinical score and health status score (r=-0.56 for men, and r=-0.55 for women, P<0.01). However, CMS clinical score was not different in groups with different Hb levels. Health status score was significantly higher in subjects without CMS. In conclusion, elevated hemoglobin levels were not associated with elevated CMS clinical score.

Functional outcomes and quality of life in patients treated with laparoscopic total colectomy for colonic inertia

PURPOSE

To assess the functional outcomes and quality of life in patients with laparoscopic total colectomy for slow-transit constipation (STC).

METHODS

All patients undergoing laparoscopic colectomy with ileorectal anastomosis for colonic inertia at two referral centers were analyzed. Their preoperative, intraoperative and postoperative details were recorded with a one-year follow-up. Their quality of life was assessed using the SF-36 questionnaire.

RESULTS

Between 2004 and 2007, 710 patients were evaluated. Eight female patients (1.1 %) fulfilled the criteria for STC without obstructive defecation syndrome. Their mean age was 38 years ± 15 (range from 22 to 62). The conversion rate was 12.5 %. The morbidity rate was 37.5 %, and mortality was nil. The preoperative abdominal pain was 6.6 ± 0.3 and had decreased to 3.6 ± 2.3 postoperatively (P = 0.008). At 1 year, the defecation frequency per week had increased from 0.84 ± 0.24 to 6.75 ± 3.4 (P = 0.001). Three patients developed nocturnal leakage (37.5 %). Eighty-eight percent of the patients recommend the procedure. All parameters of the SF-36 questionnaire had improved at the one-year follow-up examination.

CONCLUSION

Laparoscopic colectomy for slow-transit constipation is safe and increased the number of evacuations per week. Although nocturnal leakage may occur, these patients experience improvements in their quality of life.

Health-related quality of life, ethnicity and perceived discrimination among immigrants and natives in Spain

OBJECTIVES

The current study compares subjective mental and physical health among native Spaniards and immigrant groups, and examines the effects of ethnicity and perceived discrimination (PD) on subjective health in immigrants.

DESIGN

Two random samples of 1250 immigrants to Spain from Colombia, Bolivia, Romania, Morocco, and Sub-Saharan Africa and 500 native Spaniards, aged between 18 and 65, were recruited for this cross-sectional study. Several hierarchical regression analyses of ethnicity and PD on subjective mental and physical health (assessed using the health-related quality of life items, HRQLSF-12) were carried out separately for men and women.

RESULTS

Male immigrants from Colombia and Sub-Saharan Africa showed better physical health than natives, controlling for age and socioeconomic and marital status. The immigrants - except for the Colombians - had poorer mental health than natives, especially African men and Bolivian women. Socioeconomic status had no impact on these differences. Among immigrants, PD was the best predictor of physical and mental health (controlling for socio-demographic variables). African men, Bolivian women and women without legal status exhibited the poorest self-rated mental health.

CONCLUSION

Clear differences in health status among natives and immigrants were recorded. The self-selection hypothesis was plausible for physical health of Colombians and Sub-Saharan African men. Acculturation stress could explain poorer mental health in immigrants compared with natives. The association between ethnicity and poor self-reported mental health appears to be partially mediated by discrimination.

Design considerations of a randomized clinical trial on a cognitive behavioural intervention using communication and information technologies for managing chronic low back pain

Background

Psychological treatments have been successful in treating chronic low back pain (CLBP). However, the effect sizes are still modest and there is room for improvement. A way to progress is by enhancing treatment adherence and self-management using information and communication technologies (ICTs). Therefore, the objective of this study was to design a trial investigating the short- and long-term efficacy of cognitive behavioural treatment (CBT) for CLBP using or not ICTs. A secondary objective of this trial will be to evaluate the influence of relevant variables on treatment response. Possible barriers in the implementation of CBT with and without ICT will also be investigated.

Methods

A randomised controlled trial with 180 CLBP patients recruited from specialised care will be conducted. Participants will be randomly assigned to three conditions: Control group (CG), CBT, and CBT supported by ICTs (CBT + ICT). Participants belonging to the three conditions will receive a conventional rehabilitation program (back school). The CBT group program will last six sessions. The CBT + ICT group will use the internet and SMS to practice the therapeutic strategies between sessions and in the follow-ups at their homes. Primary outcome variables will be self-reported disability and pain intensity. Assessment will be carried out by blinded assessors in five moments: pre-treatment, post-treatment and 3-, 6-, and 12-month follow-ups. The influence of catastrophizing, fear-avoidance beliefs, anxiety and depression in response to treatment in the primary outcomes will also be analysed.

Discussion

This study will show data of the possible benefits of using ICTs in the improvement of CBT for treating CLBP.

Trial registration

ClinicalTrials.gov, NCT01802671

[Health-related quality of life in women working in the fishing industry measured through the Short-Form 36 questionnaire]

OBJECTIVE

To determine health-related quality of life (HRQoL) measured with the 36-item Short-Form (SF-36) questionnaire in women workers in the fishing industry, compared with norm-based values in the reference population and other similar samples of persons with musculoskeletal disorders.

METHOD

A cross-sectional study was performed to measure HRQoL in 917 shellfish gatherers. Women taking part in a physiotherapy workshop were invited to participate. We used a self-administered questionnaire, including questions on sociodemographic variables, lifestyle, comorbidity, the prevalence of musculoskeletal disorders, and HRQoL. For the SF-36 raw scores, norm-based scores and z-scores were calculated.

RESULTS

The mean age of participants was 50.6 years (standard deviation: 8.8). In all dimensions of the SF-36, values in the sample were lower than in the general reference population. The greatest differences were in younger people. The most affected dimensions were bodily pain, vitality and general health. Physical health was more affected than mental health.

CONCLUSIONS

HRQoL, especially physical components, was worse in women shellfish gatherers than in the general population and other population samples.

Validity and reliability of the SF-36 in Chilean older adults: the ALEXANDROS study

To validate short-form-36 health survey (SF-36) with specific scoring algorithm obtained in a large sample of Chilean older people and to associate quality of life in this sample with social and health related factors. A cross-sectional study on 2,143 community-living subjects aged 60-92 years (33 % men and 67 % women) conducted in Santiago, Chile. Scores in 8 scales of SF-36-physical function (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE) and mental health (MH)-, were calculated. Factor analysis was used to extract two principal factors and logistic regression model was applied to estimate its association with socio-demographic and health variables. The internal consistency of scales was high (Cronbach's alpha 0.86-0.87). Factor analysis retained two factors: mental (MCS) and physical (PCS) components accounting for 65.3 % of total variance (55.3 and 10.0 % respectively). High correlations (0.61-0.94) between MCS and MH, V, RE and SF were obtained. PCS correlated highest (0.72-0.86) with RP, PF and BP. Self-perceived symptoms of depression (GDS-15 ≥5) was the main variable explaining low scores in both MCS and PCS (adjusted OR = 26.9; 95 % CI: 15.3-47.2; OR = 3.4; 95 % CI: 2.1-5.5, respectively). We have demonstrated the reliability and validity of SF-36 questionnaire to evaluate health related quality of life, reporting Chilean-Specific factor score coefficients for MCS and PCS based in national Chilean means and standard deviations for older people. After adjusting by age and gender, the main predictors of low health related QoL in Chilean older people were self-perceived symptoms of depression, the presence of two or more chronic diseases and illiteracy. Important gender inequalities were observed in all of these results, being consistently less favorable in women than in men.

Analysis of benzodiazepine withdrawal program managed by primary care nurses in Spain

Background

Benzodiazepine (BZD), the long-term treatment of which is harmful for cognitive function, is widely prescribed by General Practitioners in Spain. Based on studies performed in other countries we designed a nurse-led BZD withdrawal program adapted to Spanish Primary Care working conditions.

Results

A pseudo-experimental (before-after) study took place in two Primary Care Centres in Barcelona. From a sample of 1150 patients, 79 were identified. They were over 44 years old and had been daily users of BZD for a period exceeding six months. Out of the target group 51 patients agreed to participate. BZD dosage was reduced every 2-4 weeks by 25% of the initial dose with the optional support of Hydroxyzine or Valerian. The rating measurements were: reduction of BZD prescription, demographic variables, the Short-Form Health Survey (SF-12) to measure quality of life, the Medical Outcomes Study (MOS) Sleep Scale, and the Goldberg Depression and Anxiety Scale.

By the end of the six-month intervention, 80.4% of the patients had discontinued BZD and 64% maintained abstinence at one year. An improvement in all parameters of the Goldberg scale (p <0.05) and in the mental component of SF-12 at 3.3 points (p = 0.024), as well as in most components of the MOS scale, was observed in the group that had discontinued BZD. No significant differences in these scales before and after the intervention were observed in the group that had not discontinued.

Conclusions

At one year approximately 2/3 of the patients had ceased taking BZD. They showed an overall improvement in depression and anxiety scales, and in the mental component of the quality of life scale. There was no apparent reduction in the sleep quality indicators in most of the analysed components. Nurses in a Primary Care setting can successfully implement a BZD withdrawal program.

Hand and wrist arthralgia in systemic lupus erythematosus is associated to ultrasonographic abnormalities

OBJECTIVE

Systemic lupus erythematosus (SLE) is an autoimmune disease which may has joint impairment. Often, SLE patients complain of hand and wrist arthralgia (HA). Usually, these patients do not show any swelling in the physical exam. Our aim was to demonstrate Power Doppler Ultrasound (PDUS) abnormalities in SLE patients with HA.

METHODS

We recruited 58 consecutive SLE patients and divided them into two groups: case group (n = 28) were patients with HA, and control group (n = 30) were patients without HA. We also collected socio-demographic and disease activity data, biological markers and SLEDAI index. We evaluated disability and quality of life by mHAQ and SF-12, respectively. We performed a bilateral hand and wrist PDUS on all patients. PDUS findings were based in OMERACT-7 group criteria.

RESULTS

We found PDUS abnormalities in most of SLE patients who suffered HA, when compared to SLE controls (P < 0.001). The main findings in Case Group were: tenosynovitis (39.2%), synovial effusion or hypertrophy (25%) and active synovitis (14.2%). SLEDAI score and dsDNA antibodies were related to the presence of PDUS abnormalities (P < 0.05 and P < 0.001, respectively). We also found worse physical SF-12 (P < 0.05) and mHAQ (NS) scores in case group.

CONCLUSIONS

SLE patients who present HA have more PDUS abnormalities. These findings are associated with a higher SLEDAI score and dsDNA antibodies. This articular affection may contribute to a worsened functional ability and a lower quality of life. PDUS seems to be a reliable tool in the assessment of SLE patients with HA.

Evaluation of primary care: The "Primary Care Assessment Tools - Facility version" for the Spanish health system

OBJECTIVE

To obtain versions of the Primary Care Assessment Tools (PCAT)-Facility version to evaluate primary care (PC) in the Spanish context, and to analyze its feasibility, reliability and validity.

METHODS

Cultural adaptation was performed through the use of forward and backward translations into Spanish and Catalan, observations and opinions of a panel of experts, and cognitive interviews with target users (PC team managers). A pilot phase was carried out in a sample of 130 managers of PC teams in Catalonia. A post-test questionnaire was sent 4-5 months later to all 194 managers of PC teams in the Barcelona health region. Analysis of metric properties included: 1) description of items and verification of Likert assumptions, since domain scores are obtained by summing item scores; 2) reliability analysis (Cronbach's alpha coefficient, Pearson's correlation coefficient, test-retest analysis); and 3) validity analysis (expert panel, cognitive interviews, and convergent and discriminant validity).

RESULTS

Substantial adaptation was required for the accessory section of the questionnaire, but less was required in PC domain measurements. Items were added to the comprehensiveness domain to reflect services usually available in Spain. The lowest Cronbach's alpha scores were found for Access (0.62) and Coordination (0.59 and 0.65), while values were >0.70 for the remaining domains.

CONCLUSION

The Spanish version of the PCAT-Facility questionnaire is now available and shows adequate reliability and validity. The Spanish PCAT version will facilitate national and international comparisons of PC and analysis of the determinants of quality of service provision.

Health-related quality of life in different clinical subgroups with typical AFL who have undergone cavo-tricuspid isthmus ablation

Background

To evaluate changes in health-related quality of life (HRQOL) in different sub-groups of a cohort of patients with typical atrial flutter (AFL) treated with cavotricuspid isthmus (CTI) radiofrequency catheter ablation.

Methods

95 consecutive patients due to undergo CTI ablation were enrolled in a study involving their completion of two SF-36 HRQOL questionnaires, before ablation and at one-year follow-up.

Results

88 of the initial 95 patients finished the study. Regardless of whether patients experienced atrial fibrillation (AF) during follow-up, a statistically significant improvement in HRQOL was observed, compared with pre-ablation scores and in all dimensions except Bodily Pain. However, patients without AF during follow-up had significantly higher absolute HRQOL scores in most dimensions. No differences were seen in most HRQOL dimensions, with respect to AFL type (paroxysmal, persistent) or duration, whether AFL was first-episode or recurrent, Class I-III drug dependent, sex, or presence of structural heart disease or tachycardiomyopathy. Patients with persistent AFL showed the greatest improvement in HRQOL when they also had a ventricular cycle length ≤500 ms. The combination of recurrent AFL, ventricular cycle length ≤500 ms and structural heart disease led to a significantly greater improvement in physical HRQOL dimensions than did first-episode AFL, no structural heart disease and ventricular cycle >500 ms. The only independent factor associated with a greater improvement was structural cardiopathy.

Conclusions

CTI-ablation treatment leads to a significant improvement in HRQOL in patients with typical AFL. Patients with AF during follow-up show a significantly lower HRQOL at one-year post-ablation. The only independent risk factor found to be associated with a greater improvement in the physical summary component was structural cardiopathy.

Quality of life in patients operated on for digestive neoplasia: a prospective study

AIM

The aim of this study was to evaluate the quality of life in patients having surgery for a digestive neoplasm and to monitor how the patient's perception evolves during the first 6 months after surgery.

METHOD

A prospective study was carried out on the pre and postoperative quality of life of patients undergoing surgery for a digestive system neoplasm between May 2009 and December 2010. Patients were asked to complete the Short Form (36) Health Survey questionnaire (SF-36; spanish version 1.4).

RESULTS

The study included 80 patients. At 1 month after surgery there was a statistically significant improvement in some domains of the SF-36. At 6 months, a statistically significant improvement was seen in physical functioning, social functioning, mental health and in the two physical and mental domains. We also found statistically significant differences, with women having a worse quality of life.

CONCLUSION

Comparison of quality of life before and 6 months after surgical intervention showed improvement in both the psychological and the physical elements. This can be attributed to the fact that the patients have had time to recover from the surgery.

Recognition of anxiety disorders by the general practitioner: results from the DASMAP study

OBJECTIVES

The objectives were to determine the levels of general practitioner (GP) recognition of anxiety disorders and examine associated factors.

METHODS

An epidemiological survey was carried out in 77 primary care centers representative of Catalonia. A total of 3815 patients were assessed.

RESULTS

GPs identified 185 of the 666 individuals diagnosed as meeting the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) criteria for any anxiety disorder (sensitivity 0.28). Regarding specific anxiety disorders, panic disorder was registered in just three of the patients who, according to the SCID-I, did not meet the criteria for this condition .Generalized anxiety disorder was recorded by the GP in 46 cases, 4 of them being concordant with the SCID-I (sensitivity 0.03). The presence of comorbid hypertension was associated with an increased probability of recognition. Emotional problems as the patients' main complaint and additional appointments with a mental health specialist were associated with both adequate and erroneous recognition. Being female, having more frequent appointments with the GP and having higher levels of self-perceived stress were related to false positives. As disability increased, the probability of being erroneously detected decreased.

CONCLUSION

GPs recognized anxiety disorders in some sufferers but still failed with respect to differentiating between anxiety disorder subtypes and disability assessment.

Environmental risk and protective factors of adolescents' and youths' mental health: differences between parents' appraisal and self-reports

PURPOSE

We investigated the effect of parents' mental health, life events, and home life (among other factors) on adolescents'/youths' mental health, whether such an effect varies when several variables are assessed jointly, and also whether the informant source of the mental health problem modifies the estimations.

METHODS

We studied a representative sample of 454 Spanish adolescents/youths studied longitudinally (2 assessments, 3 years apart). We considered factors associated with adolescents'/youths' mental health (conduct, emotional, and hyperactivity scores [SDQ]): risk factors (parents' mental health and life events) and mediators (social and financial support). Structural equation modeling was applied. We constructed two models: (a) with parents' SDQ responses and (b) with self-reported SDQ responses (in a subsample of N = 260).

RESULTS

Model fit was adequate for parents' appraisal. Parents' mental health (p < 0.05) and undesirable life events (p < 0.05) were the most important risk factors. The same model showed poorer fit when self-reported measures were used. Home life exerted a stronger protective effect on adolescents'/youths' mental health when reported by adolescents/youths. The negative effect of parents' mental health was significantly protected by home life in emotional [-0.14 (0.07)] and hyperactivity scores [-0.2 (0.08)].

CONCLUSIONS

Even in the presence of other factors, parents' mental health has an important effect on adolescents'/youths' mental health. Good levels of home life are protective, especially when adolescents'/youths' mental health is self-reported.

eVITAL: a preliminary taxonomy and electronic toolkit of health-related habits and lifestyle

Objectives. To create a preliminary taxonomy and related toolkit of health-related habits (HrH) following a person-centered approach with a focus on primary care. Methods. From 2003–2009, a working group (n = 6 physicians) defined the knowledge base, created a framing document, and selected evaluation tools using an iterative process. Multidisciplinary focus groups (n = 29 health professionals) revised the document and evaluation protocol and participated in a feasibility study and review of the model based on a demonstration study with 11 adult volunteers in Antequera, Spain. Results. The preliminary taxonomy contains 6 domains of HrH and 1 domain of additional health descriptors, 3 subdomains, 43 dimensions, and 141 subdimensions. The evaluation tool was completed by the 11 volunteers. The eVITAL toolkit contains history and examination items for 4 levels of engagement: self-assessment, basic primary care, extended primary care, and specialty care. There was positive feedback from the volunteers and experts, but concern about the length of the evaluation. Conclusions. We present the first taxonomy of HrH, which may aid the development of the new models of care such as the personal contextual factors of the International Classification of Functioning (ICF) and the positive and negative components of the multilevel person-centered integrative diagnosis model.

The effectiveness of a health promotion with group intervention by clinical trial. Study protocol

BACKGROUND

The promotion of health and the interventions in community health continue to be one of the pending subjects of our health system. The most prevalent health problems (cardiovascular diseases, cancer, diabetes...) are for the most part related to life habits. We propose a holistic and integral approach as the best option for tackling behavior and its determinants. The research team has elaborated the necessary educational material to realize group teaching, which we call "Health Workshops". The goal of the present study is to evaluate the effectiveness of these Health Workshops in the following terms: Health Related Quality of Life (HRQOL), incorporate and maintain a balanced diet, do physical activity regularly, maintain risk factors such as tension, weight, cholesterol within normal limits and diminish cardiovascular risk.

METHODS/DESIGN

Controlled and random clinical testing, comparing a group of persons who have participated in the Health Workshops with a control group of similar characteristics who have not participated in the Health Workshops.Field of study: the research is being done in Health Centers of the city of Barcelona, Spain.

POPULATION STUDIED

The group is composed of 108 persons that are actually doing the Health Workshops, and 108 that are not and form the control group. They are assigned at random to one group or the other.

DATA ANALYSIS

With Student's t-distribution test to compare the differences between numerical variables or their non parametric equivalent if the variable does not comply with the criteria of normality. (Kolmogorov-Smirnof test). Chi-square test to compare the differences between categorical variables and the Logistic Regression Model to analyze different meaningful variables by dichotomous analysis related to the intervention.

DISCUSSION

The Health Workshop proposed in the present study constitutes an innovative approach in health promotion, placing the emphasis on the person's self responsibility for his/her own health.The rhythm of a weekly session during 8 weeks with recommended activities to put into practice, as well as the support of the group is an opportunity to incorporate healthy habits and make a commitment to self-care. The sheets handed out are a Health Manual that can always be consulted after the workshop ends.

TRIAL REGISTRATION

Clinical Trials.gov Identifier: NCT01440738.

Cross-sectional evaluation of patient functioning and health-related quality of life in patients with neuropathic pain under standard care conditions

AIM

The purpose of this cross-sectional evaluation was to determine the impact of neuropathic pain (NeP) on patient functioning and Health-Related Quality of Life (HRQoL) under standard care conditions.

METHODS

Patients with NeP or neuropathic and nociceptive pain [Mixed Pain (MP)] enrolled in the DONEGA study, a naturalistic, prospective and multi-centre study of the effectiveness of gabapentin under usual care conditions, were included in this cross-sectional evaluation before starting study treatments. Participants completed the Short Form-McGill Pain Questionnaire, MOS Short Form-12 (SF-12), and Sheehan Disability Scale (ShDS). Multivariate analysis and regression models were used to analyze patient data.

RESULTS

A total of 1519 patients [mean+/-SD; 56.0+/-13.7 yrs old (58.8% female)] with NeP or MP were enrolled in the study. The mean pain history was 1.1+/-2.8 yrs, current pain intensity on a 5-point visual analogue scale was 2.8+/-1.0 and mean pain in previous week was 71.3+/-19.0mm. Pain substantially interfered (i.e., score > or = 5 on 0-10 scale) with normal work (5.9+/-3.0), social life (5.7+/-3.0), and family life (5.3+/-3.0), producing substantial disability (total ShDS score of 16.9+/-8.3 pts). Country-standardised physical (PCS) and mental health (MCS) component summary scores of SF-12 indicated significant impairment in both domains compared with the general Spanish population: PCS; -1.13+/-1.0 SDS (standard deviation score), and MCS; -1.21+/-0.7 SDS, equivalent to the 15th and 25th percentiles of normative populations, respectively.

CONCLUSIONS

Under standard care conditions, neuropathic and mixed pain are associated with impaired physical and mental QoL, producing a substantial level of disability in these patients.

Evaluation of Health-Related Quality of Life according to Carbohydrate Metabolism Status: A Spanish Population-Based Study (Di@bet.es Study)

Objective. To evaluate the association between diabetes mellitus and health-related quality of life (HRQOL) controlled for several sociodemographic and anthropometric variables, in a representative sample of the Spanish population. Methods. A population-based, cross-sectional, and cluster sampling study, with the entire Spanish population as the target population. Five thousand and forty-seven participants (2162/2885 men/women) answered the HRQOL short form 12-questionnaire (SF-12). The physical (PCS-12) and the mental component summary (MCS-12) scores were assessed. Subjects were divided into four groups according to carbohydrate metabolism status: normal, prediabetes, unknown diabetes (UNKDM), and known diabetes (KDM). Logistic regression analyses were conducted. Results. Mean PCS-12/MCS-12 values were 50.9 ± 8.5/ 47.6 ± 10.2, respectively. Men had higher scores than women in both PCS-12 (51.8 ± 7.2 versus 50.3 ± 9.2; P < 0.001) and MCS-12 (50.2 ± 8.5 versus 45.5 ± 10.8; P < 0.001). Increasing age and obesity were associated with a poorer PCS-12 score. In women lower PCS-12 and MCS-12 scores were associated with a higher level of glucose metabolism abnormality (prediabetes and diabetes), (P < 0.0001 for trend), but only the PCS-12 score was associated with altered glucose levels in men (P < 0.001 for trend). The Odds Ratio adjusted for age, body mass index (BMI) and educational level, for a PCS-12 score below the median was 1.62 (CI 95%: 1.2-2.19; P < 0.002) for men with KDM and 1.75 for women with KDM (CI 95%: 1.26-2.43; P < 0.001), respectively. Conclusion. Current study indicates that increasing levels of altered carbohydrate metabolism are accompanied by a trend towards decreasing quality of life, mainly in women, in a representative sample of Spanish population.

[Reliability of the VIDA questionnaire for assessing instrumental activities of daily living (iADL) in the elderly]

OBJECTIVE

To analyse the inter- and intra-examiner reliability of the VIDA questionnaire, and their concordance with the "timed get up and go" test in people aged ≥75 years.

DESIGN

Descriptive study of a diagnostic test.

LOCATION

Primary Health Care. SUBJECTS-INTERVENTION: Application of 71 pairs of VIDA questionnaire, by one (38) or two professionals (33), in people aged ≥75 years with no significant sensory or physical-psychic impairment. Stratified sample based on ADL (Barthel index) to obtain a variety of responses that would ensure a range of scores of the questionnaire.

MAIN MEASUREMENTS

Overall score of VIDA questionnaire, "get up and go" test (functional), Pfeiffer questionnaire (cognitive), and risk factors of frailty (comorbidity, falls, recent hospitalisation, sensory disturbance, social impairment, polypharmacy).

RESULTS

Mean age 81.3 years±4.8, with a 65.5% moderate-severe change in Barthel index. The mean score of the questionnaire was 31.3±7.9, with a rank of 11 to 38 (maximum). There were no differences according to gender (P=0.78). Inter-examiner reliability (n 33): Intraclass Correlation Coefficient (ICC) 0.94, 95% Confidence Interval (CI) 0.88-0.97, P<0.0001. Intra-examiner reliability (n 38): ICC 0.96, CI 0.93-0.98, P<0.0001. Correlation coefficient (rho of Spearman) with the "get up and go" test (n 67) 0.61 (moderate), P<0.0001. Lower score if there are ≥ 2 frailty factors (P=0.015).

CONCLUSIONS

VIDA questionnaire is a very reliable tool, with no gender bias. It demonstrates an association with other functionality measures and with frailty factors in the elderly.

Relationship between life events and psychosomatic complaints during adolescence/youth: a structural equation model approach

PURPOSE

To assess the contribution of life events (LEs) on psychosomatic complaints in adolescents/youths taking into account a set of socioeconomic variables.

METHODS

We tested a conceptual model implemented with structural equation modeling on longitudinal data from a representative sample of adolescents/youths and parents. Psychosomatic complaints were measured by the Health Behaviour in School-aged Children scale and hypothesized to be affected by: (a) contextual factors at distal level: financial resources, home life and social support (KIDSCREEN), and parent baseline mental health (SF-12); (b) triggering factors: LEs (Coddington Life Events Scales, with two typologies: desirability and familiarity); (c) intermediate factors: same as distal level but measured at follow-up; (d) immediate cause: mental health at proximal level (Strengths and Difficulties Questionnaire at baseline and follow-up); and (e) gender.

RESULTS

The structural model yielded a good fit (Comparative Fit Index = .95, Tucker-Lewis Index = .93, Root Mean Square Error = .04). Boys showed more psychosomatic complaints than girls (β = .40, p < .05). Girls reported experiencing more LEs (p < .05). Only undesirable LEs showed a significant direct negative effect on psychosomatic complaints, which became nonsignificant when mediated by home life and mental health. Undesirable LEs had a remaining indirect effects on psychosomatic complaints (βindirect = -.10, p < .05) via Home Life and Mental health, which were protective factors (β = .41 and β = -.15, p < .05).

CONCLUSIONS

The experience of undesirable LEs increases the probability of psychosomatic complaints, but the final effect would be determined by previous levels of home life and mental health stability.

Self-reported sleep duration and falls in older adults

Whether the association between sleep duration and accidental falls is independent of sleep quality is uncertain. It is also unclear if this association varies with age and sex among older adults. Data were collected through telephone interviews of 1542 community-dwelling individuals aged ≥68 years in Spain. Analyses were performed with logistic regression and adjusted for the main confounders, including lifestyle, health status, comorbidity and sleep quality, as measured by nighttime and daytime sleep complaints. Analyses were also stratified by age and sex. In total, 449 (29.1%) participants fell in the previous year; of these, 57.7% had one fall and 42.3% had recurrent (≥2) falls. As compared with those who usually slept 7-8 h, those sleeping ≥11 h were more likely to suffer recurrent falls [odds ratios (OR) 2.75; 95% confidence intervals (CI) 1.32-5.62]. In the stratified analysis, there was no association between sleep duration and falls in those aged ≤75 years and in men. In contrast, among those aged >75 years, the percentage of individuals with ≥1 falls was higher in those sleeping ≤5 h (OR 2.15; 95% CI 1.20-3.87) and ≥11 h (OR 2.34; 95% CI 1.17-4.68) than in those sleeping 7-8 h; also, women who slept ≥11 h were more likely to fall ≥1 times (OR 3.89; 95% CI 1.74-8.69). In conclusion, long sleep duration was associated with higher frequency of falls in older adults, even after adjustment for a wide range of sleep quality indicators. The association is clearer in women and the oldest adults. Assessment of sleep duration can help identify older adults who might benefit from interventions aimed at fall prevention.

Comparative study of the quality of life between arthrodesis and total arthroplasty substitution of the ankle

Our goal was to compare the health status of patients with primary and secondary arthrosis of the ankle before and after arthrodesis or total substitution arthroplasty, and to determine the improvement in quality of life and whether there is any difference between these techniques. A prospective comparative study of clinical-functional evaluation was performed using the American Orthopaedic Foot & Ankle Society (AOFAS) scale and quality of life with the short form (SF)-36 questionnaire in patients who underwent arthrodesis (16 cases) or total substitution arthroplasty of the ankle (14 cases) after 2 years (mean, 25.2 months) of follow-up after surgery, in comparison with the baseline preoperative status. In this series of comparable patients, both techniques showed a statistically significant improvement with regard to the clinical evaluation and quality of life after 2 years of follow-up; the arthrodesis group increased from mean AOFAS values of 37.12 to 45.62 (P = .055) and mean SF-36 values of 32.96 to 46.25 (P = .008), whereas in the arthroplasty group the mean values of AOFAS increased from 33 to 62 (P = .024) and SF-36 from 33.62 to 59.84 (P = .001). Nevertheless, in all cases the improvement was statistically greater in patients who underwent arthroplasty than in those who underwent arthrodesis (P = .048 for AOFAS, and P = .026 for SF-36). In conclusion, arthrodesis and arthroplasty represent good options in the surgical treatment of ankle arthrosis, providing both a significant improvement in function and in the health perception and quality of life of the patient. New-generation total ankle substitution arthroplasty provides an improvement in the quality of life and perception of general health of the patient with arthrosis of this joint, when this technique is compared with surgical fusion.

The association between habitual sleep duration and sleep quality in older adults according to health status

BACKGROUND

research on the association between habitual sleep duration and quality in older adults is scarce and has shown conflicting results. Moreover, no previous study has assessed the influence of health status on this association.

OBJECTIVES

to examine the association between habitual duration and quality of sleep in older adults, and to test if this association varies with health status, as approximated by self-rated health, quality-of-life and functional limitation.

DESIGN

cross-sectional study with data collected by telephone interview.

SETTING

community-based study.

SUBJECTS

a total of 1,567 community-dwelling individuals aged ≥68 years in Spain.

METHODS

poor sleep quality was ascertained through nighttime complaints (sleeping-pill consumption, difficulty falling asleep, awakening during the night and early awakening), and daytime complaints (feeling unrested in the morning and daytime sleepiness). The analyses were adjusted for the main confounders, and were stratified by health status (self-rated health, health-related quality-of-life and functional limitation).

RESULTS

when compared with those sleeping 7-8 h, those who slept ≤6 h were more likely to report difficulty falling asleep [odds ratio (OR) 3.51; 95% confidence interval (CI) 2.37-5.20], frequent awakening during the night (OR 1.97; 95% CI 1.42-2.75), early awakening in the morning (OR 2.78; 95% CI 2.02-3.82) and feeling unrested in the morning (OR 1.73; 95% CI 1.18-2.54). Moreover, those who slept ≥9 h were more likely to report daytime sleepiness (OR 1.68; 95% CI 1.17-2.42). In stratified analyses, these associations generally did not vary with health status.

CONCLUSIONS

in older adults, short sleep is associated with nighttime sleep complaints and feeling unrested in the morning, while long sleep is associated with daytime sleepiness.

Inappropriate overuse of inhaled corticosteroids for COPD patients: impact on health costs and health status

The aim of this study was to evaluate the relationship between inappropriate overuse of inhaled corticosteroids and self-reported health status and the annual cost of patients with stable chronic obstructive pulmonary disease (COPD) recruited in the primary-care setting. An observational, crossover, descriptive study was conducted. Patients with stable COPD and aged ≥40 years, evaluated in primary care, were included. Data collected were demographic variables, clinical characteristics, self-reported health status (SF-12), the severity of the illness, treatment, and health-care resource utilization in the past year. The patients were recruited during a period of 3 months (from January 1 to March 31, 2003). Use was considered inappropriate when corticosteroids were prescribed by physicians for patients not meeting criteria for its use as recommended in guidelines. A total of 10,711 patients [75.6% males; mean age = 67.1 (SD = 9.66) years] were evaluated. Disease severity was mild in 35.5% of the cases, moderate in 53.4%, and severe in 11.2%. Among them, 3,697 (34.5%) subjects were prescribed inhaled corticosteroids or drug combinations containing such therapies, with a rate of inappropriate use of 18.2%. Physical health status was significantly lower among patients showing inappropriate corticosteroids use: 37.35 (SD = 9.53) vs. 40.7 (SD = 9.80) (p < 0.05). The annual cost per patient of COPD management was significantly higher in the group with inappropriate inhaled corticosteroids use: <euro>1,590 (SD = 1,834) vs. <euro>1,157 (SD = 1,536) (p < 0.05). Factors statistically associated with inappropriate use of corticosteroids were educational attainment [OR: 2.77 (95% CI: 1.36-5.63) for nonuniversity training], a history of heart disease [OR: 1.42 (95% CI: 1.02-1.97)], depression [OR: 1.47 (95% CI: 1.05-2.05)], any allergy [OR 1.69 (95% CI: 1.13-2.54)], and physical health status [OR 0.97 (95% CI: 0.96-0.98)]. Lack of adherence to the recommended criteria for using inhaled corticosteroids therapy in the management of COPD patients was associated with lower self-reported health status and higher costs. Factors statistically associated with inappropriate use of corticosteroids were educational attainment, a history of heart disease, depression, any allergy, and physical health status.

Daytime sleepiness and quality of life: are they associated in obese pregnant women?

OBJECTIVE

To know the relationship between daytime sleepiness and quality of life during pregnancy according to the weight gain and baseline weight.

METHODS

We studied 216 pregnant women (108 obese and 108 non-obese). At first and third trimester of pregnancy they completed the 12-item short-form health survey (SF-12) and the Epworth Sleepiness Scale (ESS). Furthermore, in both visits, we evaluated blood pressure, body mass index (BMI), and reviewed all medical charts to identify pregnancy complications.

RESULTS

Weight gain and mental component of quality of life (MCS-12) in both trimesters were lower in the obese group, whereas ESS was higher. The physical component of quality of life (PCS-12) was only lower in the same group at third trimester. Those women with ESS ≥ 10 at third trimester showed a higher baseline BMI and ESS score, but lower MCS-12 and PCS-12 at third trimester. Baseline and final BMI were positively associated with ESS at third trimester, whereas PCS-12 value in both trimesters was negatively related.

CONCLUSIONS

Obesity at the beginning of pregnancy but not weight gain was related to low quality of life and daytime sleepiness at the third trimester of gestation. High BMI but low PCS-12 during pregnancy was associated with daytime sleepiness.

Functional outcome and quality of life in victims of terrorist explosions as compared to conventional trauma

BACKGROUND

Following trauma, the number of preventable deaths is low. Outcome should also be measured in terms of quality of life (QoL). Studies analyzing QoL in trauma patients have been published, but little is known about the long term QoL of victims of terrorist attacks.

METHODS

This is a case-control study of casualties of the March 11, 2004 attacks in Madrid. Patients treated for other trauma with similar age and Injury Severity Score (ISS), served as controls. Patients were assessed using the POLO-Chart (VAS, SF-36 and TOP).

RESULTS

Fifty-eight patients were included, 32 casualties admitted following the March 11, 2004 attacks and 26 controls. Both groups were comparable in age (average = 37), ISS (average = 23) and time from trauma (average = 1,770 days). Subjects demonstrated lower scores for the VAS, and the SF-36 clusters social functioning, role emotional and mental health. There was a tendency towards higher prevalence of symptoms associated to posttraumatic stress disorder (PTSD) in subjects (p = 0.056). Subjects suffered from higher residual pain in the head region (p = 0.032). Strong association was found between the presence of symptoms associated to depression, anxiety and PTSD and worse QoL (p < 0.001).

CONCLUSION

Subjects present more emotional distortions, residual pain in the head region and a tendency towards a worsened perception of their own health and wellness. They also present symptoms associated to PTSD more frequently. The presence of symptoms associated to PTSD, depression or anxiety was an independent variable related to lower QoL in both groups.

Effect of pregabalin in the treatment of refractory neck pain: cost and clinical evidence from medical practice in orthopedic surgery and rehabilitation clinics

BACKGROUND

The study aims to prospectively analyze the effect of adding pregabalin upon costs and consequences in the treatment of refractory neck pain under routine medical practice.

METHODS

A secondary analysis was carried out including patients over 18 years, with 6-month chronic neck pain refractory from a prospective, naturalistic, 12-week two-visit study. The analysis compared patients adding pregabalin to its therapy vs. usual care. Severity of pain, healthcare resources utilization, lost workday equivalents (LWDE) because of pain, and related cost-adjusted reductions were assessed.

RESULTS

A total of 312 patients (65.3% women, age 54.2 [12.1] years), 78.2% receiving pregabalin, were analyzed. Adding pregabalin was associated with higher adjusted reduction in pain severity: -3.2 (1.8) points, 55.4% responders (≥50% baseline pain reduction) vs. -2.3 (2.0) and 38.2%, respectively; P<0.001, yielding a higher reduction in mean LWDE: 20.1 (23.1) vs. 8.2 (22.4); P=0.014, which produced significant reductions in the indirect components of cost: €1,041.0 (1,222.8) vs. €457.3 (1,132.1), P=0.028. The costs of pregabalin (€309.8 [193.2] vs. €26.4 [79.6], P<0.001) was offset by higher numerical reductions in the other components of costs, producing similar direct cost reductions in both groups at the end of the study: €66.8 (1,080.8) and €143.5 (1,922.4), respectively; P=0.295.

CONCLUSION

Compared with usual care, the addition of pregabalin to treat refractory neck pain seems to be associated with a higher reduction in pain severity and lost work-days equivalents, which in turn results in a greater reduction of the indirect components of cost while maintaining similar healthcare cost levels despite its higher price.

Validation of a computer-adaptive test to evaluate generic health-related quality of life

Background

Health Related Quality of Life (HRQoL) is a relevant variable in the evaluation of health outcomes. Questionnaires based on Classical Test Theory typically require a large number of items to evaluate HRQoL. Computer Adaptive Testing (CAT) can be used to reduce tests length while maintaining and, in some cases, improving accuracy. This study aimed at validating a CAT based on Item Response Theory (IRT) for evaluation of generic HRQoL: the CAT-Health instrument.

Methods

Cross-sectional study of subjects aged over 18 attending Primary Care Centres for any reason. CAT-Health was administered along with the SF-12 Health Survey. Age, gender and a checklist of chronic conditions were also collected. CAT-Health was evaluated considering: 1) feasibility: completion time and test length; 2) content range coverage, Item Exposure Rate (IER) and test precision; and 3) construct validity: differences in the CAT-Health scores according to clinical variables and correlations between both questionnaires.

Results

396 subjects answered CAT-Health and SF-12, 67.2% females, mean age (SD) 48.6 (17.7) years. 36.9% did not report any chronic condition. Median completion time for CAT-Health was 81 seconds (IQ range = 59-118) and it increased with age (p < 0.001). The median number of items administered was 8 (IQ range = 6-10). Neither ceiling nor floor effects were found for the score. None of the items in the pool had an IER of 100% and it was over 5% for 27.1% of the items. Test Information Function (TIF) peaked between levels -1 and 0 of HRQoL. Statistically significant differences were observed in the CAT-Health scores according to the number and type of conditions.

Conclusions

Although domain-specific CATs exist for various areas of HRQoL, CAT-Health is one of the first IRT-based CATs designed to evaluate generic HRQoL and it has proven feasible, valid and efficient, when administered to a broad sample of individuals attending primary care settings.

[Development and validation of a generic questionnaire for evaluating satisfaction in patients with chronic disease: the SAT-Q Questionnaire]

OBJECTIVES

To develop and validate a brief general questionnaire to assess satisfaction in patients with chronic disease.

DESIGN

epidemiological, observational, multicentre cross-sectional study.

LOCATION

4 Primary Health Care Centers from the IV Health Area in the Principality of Asturias.

SUBJECTS

A total of 202 patients diagnosed with chronic illness who were following a pharmacological regimen for at least one year.

METHODS

An extensive literature review was conducted to create an initial item pool of 61 questions regarding patient satisfaction. Then, a forward-backward translation into Spanish was carried out. Next, both the expert (n=8) and patient (n=30) panels led to a new version of 34 items (concerning satisfaction with medication and satisfaction with health service). Finally, scale item reduction (item-total correlation and exploratory factorial analysis -EFA-) and psychometrical validation (feasibility, reliability and criterion validity) of the SAT-Q- were evaluated. Both the SAT-Q and the SF-12 (to assess patient health related quality of life) were applied.

RESULTS

Item reduction analysis resulted in 18 items: general satisfaction with medication (3), adverse-events (3), oversights (2), effectiveness (3), convenience (4) and Health services (3). Internal consistency (Cronbach α) and Intraclass Correlation Coefficients were moderate-high. Moreover, significant positive correlations between SAT-Q scores and SF-12 Physical and Mental Summary Components were found (with the exception of oversights).

CONCLUSIONS

A brief questionnaire for measuring satisfaction in chronic patients has been developed and preliminary validated.

Impact of severity and type of depression on quality of life in cases identified in the community

BACKGROUND

The impact of different levels of depression severity on quality of life (QoL) is not well studied, particularly regarding ICD-10 criteria. The ICD classification of depressive episodes in three levels of severity is also controversial and the less severe category, mild, has been considered as unnecessary and not clearly distinguishable from non-clinical states. The present work aimed to test the relationship between depression severity according to ICD-10 criteria and several dimensions of functioning as assessed by Medical Outcome Study (MOS) 36-item Short Form general health survey (SF-36) at the population level.

METHOD

A sample of 551 participants from the second phase of the Outcome of Depression International Network (ODIN) study (228 controls without depression and 313 persons fulfilling ICD criteria for depressive episode) was selected for a further assessment of several variables, including QoL related to physical and mental health as measured with the SF-36.

RESULTS

Statistically significant differences between controls and the depression group were found in both physical and mental markers of health, regardless of the level of depression severity; however, there were very few differences in QoL between levels of depression as defined by ICD-10. Regardless of the presence of depression, disability, widowed status, being a woman and older age were associated with worse QoL in a structural equation analysis with covariates. Likewise, there were no differences according to the type of depression (single-episode versus recurrent).

CONCLUSIONS

These results cast doubt on the adequacy of the current ICD classification of depression in three levels of severity.

Psychometric properties of the Spanish form of the Schedule for Meaning in Life Evaluation (SMiLE)

OBJECTIVE

The objective of this study was to validate the Spanish version of the SMiLE (Schedule for Meaning in Life Evaluation). The SMiLE is a respondent-generated instrument: respondents are first asked to list three to seven areas, which provide meaning to their lives, and then to rate their current satisfaction with the listed areas, as well as the individual importance of each one. Indices of total weighting (IoW), total satisfaction (IoS), and total weighted satisfaction (IoWS) are calculated.

METHODS

Two hundred and fifty University students responded to the Spanish version of the SMiLE, as well as to instruments for measuring self-esteem, quality of life, depression, and anxiety.

RESULTS

The Cronbach alphas (α = 0.61 for IoS and α = 0.41 for IoW) and test-retest correlations were comparable to those found in the initial validation of the instrument (IoS: r = 0.55; IoW: r = 0.61). The SMiLE showed positive correlations with self-esteem (r = 0.28, P < 0.05 for IoS) and the mental dimension of the quality of life scale (r = 0.31, P < 0.05 for IoS), while negative correlations were observed with depression (r = -0.23, P < 0.01) and anxiety (r = -0.17, P < 0.05).

CONCLUSIONS

The results support the validity of the Spanish version of the SMiLE as an instrument for assessing meaning in life.

Quality-of-Life Impact of Primary Treatments for Localized Prostate Cancer in Patients Without Hormonal Treatment

Purpose

Earlier studies evaluating the effect on quality of life (QoL) of localized prostate cancer interventions included patients receiving adjuvant hormone therapy, which could have affected their outcomes. Our objective was to compare the QoL impact of the three most common primary treatments on patients who were not receiving adjuvant hormonal treatment.

Patients and Methods

This was a prospective study of 435 patients treated with radical prostatectomy, external-beam radiotherapy, or brachytherapy. QoL was assessed before and after treatment with the Short Form-36 and the Expanded Prostate Cancer Index Composite. Differences between groups were tested by analysis of variance. Distribution of outcome at 3 years was examined by stratifying according to baseline status. Generalized estimating equation models were constructed to assess the effect of treatment over time.

Results

Compared with the brachytherapy group, the prostatectomy group showed greater deterioration on urinary incontinence and sexual scores but better urinary irritative-obstructive results (−18.22, −13.19, and +6.38, respectively, at 3 years; P < .001). In patients with urinary irritative-obstructive symptoms at baseline, improvement was observed in 64% of those treated with nerve-sparing radical prostatectomy. Higher bowel worsening (−2.87, P = .04) was observed in the external radiotherapy group, with 20% of patients reporting bowel symptoms.

Conclusion

Radical prostatectomy caused urinary incontinence and sexual dysfunction but improved pre-existing urinary irritative-obstructive symptoms. External radiotherapy and brachytherapy caused urinary irritative-obstructive adverse effects and some sexual dysfunction. External radiotherapy also caused bowel adverse effects. Relevant differences between treatment groups persisted for up to 3 years of follow-up, although the difference in sexual adverse effects between brachytherapy and prostatectomy tended to decline over long-term follow-up. These results provide valuable information for clinical decision making.

[Population based norms of the Spanish version of the SF-12V2 for Murcia (Spain)]

OBJECTIVE

Questionnaires on perceived health provide information on health results. Reference values are needed to assess these results. Previous studies have provided Spanish population-based norms for the SF-12v1. The aim of this study was to obtain the population-based norms for the Spanish version of the SF-12v2 for Murcia.

METHODS

A cross-sectional telephone survey was carried out in 3,486 community-dwelling persons aged over 18 years old in the region of Murcia. The central tendency, dispersion and percentiles were calculated for each of the eight scales and the physical and mental summary components (PCS and MCS) of the SF-12v2. Known groups were compared to evaluate construct validity (Student's t-test and ANOVA).

RESULTS

A total of 3, 381 persons took part in the study (50.5% men). The mean age was 43.6 years in men and 46.0 in women. The mean PSC was 48.6 (± 10.6) and the mean MCS was 53.6 (± 10.7). These scores were higher (more favorable) in men, the youngest age groups, in persons with higher education and in those no chronic illnesses (p=0.000). In all the dimensions and summary components, men had better scores than women. The dimension with the worst score in both men and women was general health and the PCS.

CONCLUSIONS

These results should be considered as the population-based norms for the Spanish version of the SF-12v2 for Murcia but may also be useful to establish health aims in similar populations.

Validation of the Spanish version of the Kansas city cardiomyopathy questionnaire

INTRODUCTION AND OBJECTIVES

The Kansas City Cardiomyopathy Questionnaire (KCCQ) is specifically designed to evaluate quality of life in patients with chronic heart failure (CHF). The purpose of this study was to assess the reliability, validity, and responsiveness to change of the Spanish version of the KCCQ.

METHODS

The multicenter study involved 315 patients with CHF. Patients were evaluated at baseline and at weeks 24 and 26. The KCCQ, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and the Short Form-36 (SF-36) were administered. Reliability was assessed in stable patients (n=163) by examining test-retest and internal consistency measures between weeks 24 and 26. Validity was evaluated at baseline (n=315) by determining how KCCQ scores varied with New York Heart Association functional class and by comparing scores with those on similar domains of the MLHFQ and SF-36. Responsiveness to change was assessed in patients who experienced significant clinical improvement between baseline and week 24 (n=31) by determining the effect size.

RESULTS

Reliability coefficients ranged between 0.70 and 0.96 for the different domains. Mean KCCQ scores varied significantly with New York Heart Association functional class (P<.001). Correlations with comparable domains on the other questionnaires were acceptable (e.g. for physical limitation, they were between 0.77 and 0.81). The changes observed at 24 weeks in the majority of KCCQ scores in the subsample that improved corresponded to a moderate effect size (i.e. 0.4-0.6).

CONCLUSIONS

The Spanish version of the KCCQ has good metric properties (i.e. validity, reliability and responsiveness), which make it suitable for use in evaluating quality of life in Spanish CHF patients.

A cost-consequence analysis of pregabalin versus usual care in the symptomatic treatment of refractory low back pain: sub-analysis of observational trial data from orthopaedic surgery and rehabilitation clinics

BACKGROUND

low back pain is one of the most common reasons for outpatient consultation in both the primary-care and specialized-care settings. However, few studies have explored the effect of pregabalin in this context.

OBJECTIVE

to prospectively analyse the effect of adding pregabalin on costs and consequences in the treatment of refractory low back pain in routine medical practice.

METHODS

a secondary analysis was carried out in patients aged >or=18 years with a 6-month history of chronic refractory low back pain who had participated in a previous prospective, naturalistic, 12-week, two-visit study (RADIO study). The analysis compared patients receiving pregabalin with those receiving usual care. Severity of pain, healthcare resources utilization, lost workday equivalents due to pain, and related cost-adjusted reductions were assessed. The year of costing for all cost data reported in the study was 2007.

RESULTS

data from a total of 683 patients (49.5% women, mean age 55.0 years), 82.6% of whom were receiving pregabalin, were analysed. Pregabalin was associated with a higher covariable-adjusted reduction in severity of pain, i.e. mean (SD) -3.4 (2.0) compared with -2.0 (2.1) points with usual care on a 10-point neuropathic pain questionnaire (p < 0.001), and a 61.6% response rate (defined as >/=50% reduction in pain from baseline) compared with 37.3% with usual care (p < 0.001). This resulted in fewer lost workday equivalents in the pregabalin group versus usual care (27.8 vs 34.6, p = 0.002), which produced more significant adjusted reductions in indirect costs, i.e. mean (SD) -euro961.8 (euro1242.9) compared with -euro625.8 (euro1169.2) with usual care (p = 0.004). The cost of pregabalin, i.e. mean (SD) euro303.8 (euro175.8) compared with euro37.1 (euro97.0) for usual care (p < 0.001), was offset by larger reductions in the other cost components. While the adjusted total costs were substantially reduced in both groups, pregabalin-treated patients showed more significant reductions, i.e. mean (SD) -euro991.5 (euro1702.3) compared with -euro579.3 (euro2410.3) with usual care (p = 0.023).

CONCLUSION

compared with usual care, addition of pregabalin to existing therapy for refractory low back pain was associated with a larger reduction in pain severity and lost workday equivalents. The acquisition cost of pregabalin was offset by a higher reduction in the indirect components of cost, resulting in a significant decrease in total costs.

Body Image Perception and Quality of Life in Patients who Underwent Breast Surgery

Quality of Life (QoL) has become a standard measure in assessing the effectiveness of medical interventions. We compared the differences between QoL and body image scale (BIS) in a group of patients who underwent breast surgery, including lumpectomy or conservative surgery, modified radical mastectomy and radical mastectomy with breast reconstruction. We included patients who underwent breast surgery between August of 2005 and June of 2006 in two tertiary referral centers in Mexico City. Two self-administered questionnaires assessing body image perception, BIS and quality of life (SF-36), were assigned and a physician-conducted interview was done. We stratified patients by age, marital status, and scholar grade. The sample comprised 202 patients. The BIS results yielded: the group with a benign lesion demonstrated favorable body image perception when compared with the malignant lesion group. A confirmed diagnosis of malignancy hinders QoL in older and younger age groups. Conservative surgery and breast reconstruction improves QoL in younger patients without significance in the older group. The most significant variable that hinders the BIS and QoL is the cancer diagnosis. Impact of conservative surgery and breast reconstruction in body image perception and quality of life is influenced by patient age and educational level.